Is first-line single-agent mitoxantrone in the treatment ofhigh-risk metastatic breast cancer patients as effective as combination chemotherapy? No difference in survival but higher quality of life were found in a multicenter randomized trial

Abstract

No significant difference was detected between the treatment with mitoxantrone as a single agent and the combination of low-dose FEC in terms of response or survival; therefore, the imperative of the necessity of first-line combination chemotherapy for patients with high-risk metastatic breast cancer may be questioned. Since toxicity and quality of life score favored the single-agent mitoxantrone treatment arm, this treatment may be offered to patients preferring quality of life to a potential small prolongation of survival.

International Guidelines for Management of Metastatic Breast Cancer: Combination vs Sequential Single-Agent Chemotherapy

“…However, compared with epirubicin alone, use of these combinations did not prolong progression-free interval or OS (17). Comparable results have also been reported in a study in Finland (18) with a similar design and in a study in Germany (19) using single-agent mitoxantrone as the reference regimen. The study in Finland (18) was one of the few studies to clearly compare a sequential single-agent strategy with a combination approach throughout the course of illness.…”

Quality of life in randomized trials of cytotoxic or hormonal treatment of advanced breast cancer. Is there added value?

“…In 12 trials (4041 patients, 37%) [12,14,15,18,22,24,27,29,[35][36][37][39][40][41] the authors used QoL findings in the abstract as a part of their decision- making process for choosing the best treatment option. Three of these 12 studies considered QoL as a primary endpoint [14,15,35,36].…”

“…Three of these 12 studies considered QoL as a primary endpoint [14,15,35,36]. Eight trials (2828 patients, 26%) [12,14,15,22,24,26,27,29,36,40] reported significantly (p<0.05) more favourable outcomes in terms of QoL (five compared different drugs, three compared different schedules) and in seven it was also possible to identify the specific QoL dimension involved (one only physical dimension [24], two only psychological dimension [26,36], four both [12,14,15,27,29]). Two of the eight studies considered QoL as a primary outcome measure [14,15,36].…”

Chemotherapy and quality of life in metastatic breast cancer: taking stock

“…Les toxicité s de grades 3 et 4 é taient, dans pratiquement tous les cas, plus fré quentes pour les associations. Par contre, seulement deux é tudes montraient une diffé rence significative entre les deux bras pour les scores de QdV pour certains paramè tres (é tude FEC versus mitoxantrone) [33] ou à certains temps de mesure (é tude gemcitabine plus paclitaxel versus paclitaxel) [45]. Dans l'interpré -tation clinique des ré sultats de QdV obtenus dans cette derniè re é tude, Hopwood et al observaient que l'amé lioration de la QdV é tait significativement associé e à la ré ponse tumorale et au nombre de cycles complé té s tandis qu'une alté ration de la QdV é tait plutô t associé e à la dé té rioration du fonctionnement et de l'é tat psychologique plutô t qu'à la toxicité du traitement [36].…”